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Changes in Health and Antiretroviral Adherence Among HIV-Infected Adults in Kenya: Qualitative Longitudinal Findings from a Livelihood Intervention

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Abstract

This longitudinal qualitative study sought to understand how and why a livelihood intervention affected the health and health behaviors of HIV-infected Kenyan adults. The intervention included a microfinance loan, agricultural and financial training, and a human-powered water pump. In-depth interviews were conducted at two time points with intervention and control participants and program staff. We double coded interviews (n = 117) and used thematic content analysis of transcripts following an integrative inductive–deductive approach. Intervention participants described improvements in HIV health, including increased CD4 counts and energy, improved viral suppression, and fewer HIV-related symptoms. Better health was linked to improved clinic attendance and ART adherence through several mechanisms: (1) reductions in food insecurity and abject hunger; (2) improved financial stability; (3) improved productivity which enhanced social support; (4) better control over work situations; and, (5) renewed desire to prioritize their own health. Livelihood interventions may improve health by influencing upstream determinants of health behavior including food security and poverty.

Resumen

Este estudio cualitativo longitudinal trató de comprender por qué y de qué manera una intervención sustento impactó la salud y los comportamientos de salud de adultos kenianos infectados por el VIH. La intervención incluyó un préstamo de microfinanzas, capacitación agrícola y financiero, y una bomba de agua de propulsión humana. En dos puntos se llevaron a cabo entrevistas en profundidad con participantes de la intervención y del grupo del control, y el personal del programa. Doble-codificamos las entrevistas (n = 117) y utilizamos un análisis de contenido temático para las transcripciones, según un enfoque inductivo-deductivo integrado. Participantes de la intervención describieron mejor salud del VIH, recuentos de CD4 aumentados, mayor energía, mejor supresión viral, y menos síntomas de enfermedad asociados con el VIH. Mejor salud estaba vinculada a mejor asistencia clínica y cumplimiento de la terapia antiretroviral a través de varios mecanismos: 1) la reducción de la inseguridad alimentaria y el hambre extrema; 2) mejor estabilidad financiera; 3) mejor productividad, que aumentó apoyo social; 4) mejor control sobre situaciones laborales; y, 5) deseos renovados de priorizar a su propia salud. Intervenciones sustentos pueden mejorar la salud por influir los niveles iniciales de factores determinantes a los comportamientos de salud, incluyendo la seguridad alimentaria y la pobreza.

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Acknowledgments

We gratefully acknowledge the important support of the Kenyan Medical Research Institute (KEMRI) and Family AIDS Care & Educational Services (FACES). We also thank the women and men who generously gave their time to participate in the study. We gratefully acknowledge the Director of KEMRI and the Director of KEMRI’s Centre for Microbiology for their support in conducting this research. We also thank the Kevin Kadede, Priscah Owato, Pamela Kimwele, Gina Clark, Kyle Pusateri, and Nandy Nittur for their important contributions to this research.

Funding

This study was funded by National Institute of Mental Health (grant R34MH094215). Additional funding was provided by the World Food Programme and the Burke Family foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Division of HIV, ID, and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0874, 995 Potrero Avenue, San Francisco, CA, 94110, USA

    Sheri D. Weiser, Abigail M. Hatcher & Lee L. Hufstedler

  2. Center of Expertise in Women’s Health & Empowerment, University of California Global Health Institute, San Francisco, CA, USA

    Sheri D. Weiser, Abigail M. Hatcher, Shari L. Dworkin & Craig R. Cohen

  3. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Abigail M. Hatcher

  4. Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

    Elly Weke & Elizabeth A. Bukusi

  5. Department of Social and Behavioral Sciences and Center for AIDS Prevention Studies (CAPS), UCSF, San Francisco, CA, USA

    Shari L. Dworkin

  6. Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, CA, USA

    Elizabeth A. Bukusi, Rachel L. Burger & Craig R. Cohen

  7. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Stephen Kodish

  8. World Food Program, San Salvador, El Salvador

    Nils Grede

  9. Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA

    Lisa M. Butler

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  1. Sheri D. Weiser
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  9. Nils Grede
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  10. Lisa M. Butler
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  11. Craig R. Cohen
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Correspondence to Sheri D. Weiser.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Weiser, S.D., Hatcher, A.M., Hufstedler, L.L. et al. Changes in Health and Antiretroviral Adherence Among HIV-Infected Adults in Kenya: Qualitative Longitudinal Findings from a Livelihood Intervention. AIDS Behav 21, 415–427 (2017). https://doi.org/10.1007/s10461-016-1551-2

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